Healthcare Provider Details

I. General information

NPI: 1639203508
Provider Name (Legal Business Name): ARISTOTLE A RABANAL MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

OAKMOUND 409
CLARKSBURG WV
26302-0409
US

IV. Provider business mailing address

PO BOX 409
CLARKSBURG WV
26302-0409
US

V. Phone/Fax

Practice location:
  • Phone: 304-623-6517
  • Fax: 304-624-1004
Mailing address:
  • Phone: 304-623-6517
  • Fax: 304-624-1004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ARISTOTLE A RABANAL
Title or Position: OWNER
Credential: MD
Phone: 304-623-6517